We hear a lot about post-traumatic stress, but what is it really? Can one suffer from post-traumatic stress even though one has not really experienced a traumatic event?
1. What is post-traumatic stress?
According to the INSERM (National Institute of Health and Medical Research) definition, post-traumatic stress is classified as a psychiatric disorder that can occur after a traumatic event. PTSD (Post-Traumatic Stress Disorder) will have significant psychological consequences long after the event.
Post-traumatic stress is present in approximately 5 to 12% of the population. However, like many of the figures concerning pathologies, it is surely underestimated, due to the absence of diagnosis in some people.
In other words, post-traumatic stress can be likened to an important emotional shock. This emotional shock will have a direct impact on the daily life of the person suffering from it in different ways.
2. What are the symptoms of post-traumatic stress?
There are many symptoms that accompany PTSD. Among the main symptoms are:
Reliving is the act of “reliving” the event repeatedly. People can relive their trauma in different ways: Through repeated flashbacks that will cause the person to relive the entire scene; intrusions of involuntary thoughts and images related to the traumatic event; recurring nightmares. Any external event can bring back the memory of the traumatic event: a noise, a light, a person, a place… These different external signals will automatically trigger anxiety symptoms
Avoidance is one of the main reasons for maintaining post-traumatic stress. Indeed, people will tend to avoid the places of the trauma, objects or people for example.
There are different types of avoidance: emotional avoidance (e.g., never again feeling the same type of emotion as those present during the trauma); cognitive avoidance (e.g., avoiding thinking about the trauma that took place) and behavioral avoidance (e.g., not returning to the scene of the accident). This avoidance will be worked on in therapy. Indeed, it is necessary, little by little, to avoid avoidance.
This avoidance can have a significant impact on people’s professional and personal lives. People can develop various phobias. We will come back to this a little later.
- Hypervigilance, concentration difficulties, sleep disorders… Various cognitive disorders may be linked to the trauma.
- Mood disorders such as emotional outbursts (anger, sadness) or, on the contrary, an emotional blunting (decrease in affectivity).
3. What events can create PTSD?
Different elements can lead the patient to develop post-traumatic stress afterwards. Among the most common are attacks, assaults, rapes, sudden deaths of loved ones, all types of accidents, natural disasters…
It is not necessary to have experienced a traumatic event to suffer from it, the fact of having witnessed these same events can also be the source of the appearance of a PTSD.
As you can see, PTSD can develop when a person is confronted with an imminent threat of death, when his or her physical integrity may be affected, or when a loved one is significantly affected by a serious event.
Thus, we can find two types of post-traumatic stress:
- Type 1 “simple” PTSD
This type of trauma occurs after a single, isolated and brutal event. In this type of trauma, we can find everything that is an accident, natural disaster, aggression…
- Type 2 “complex” PTSD
This type of trauma occurs following prolonged and repeated exposure to a certain type of event. Here, we will find traumas related to repeated physical or psychological abuse, sexual violence, harassment…
There are different ways to be a victim of a traumatic event.
- A person can be a direct victim, that is, be directly exposed to the event.
- A person can also be an indirect victim: for example, a person who witnessed an incident or the relatives of direct victims.
- There is also a third category, which is the secondary victims: in this category, we find people whose job is to provide care, i.e. doctors, firemen, ambulance drivers, etc.
In the indirect victims of post-traumatic stress, we can also find the viewers. Indeed, several studies have examined the impact of the media on the development of post-traumatic stress in people who have not witnessed the event. For example, we all remember that complicated period of regular attacks. These were omnipresent in the media. For example, a study was done on the mediation of the November 2015 attacks in Paris (Enguerrand du Roscoät et al.,). This study shows that people who had high or very high exposure to media images (from 2 to more than 4 hours per day) are likely to develop symptoms of post-traumatic stress. Thus, the over-mediatization of images of the attacks is associated with an increase in post-traumatic stress symptoms in the general population.
4. What impact can this post-traumatic stress have?
When the event is part of a post-traumatic stress disorder, it can have a significant impact on the daily life of the person suffering from it. Indeed, little by little, various phobias or psychiatric disorders may develop as a result of this trauma.
In the associated disorders, we can find mostly phobias related to public places such as generalized anxiety, agoraphobia or social phobia.
Among the comorbidities, it is not uncommon to also find alcohol addiction problems or a depressive comorbidity.
As previously mentioned, a trauma will lead to the development of significant psychological distress that will impact different spheres of one’s life, whether it be personal or professional. The person will avoid certain situations. For example, a person who has been in a car accident is no longer able to drive because it makes him or her anxious. The fact of not being able to take his car will prevent him from participating in certain activities with his family. A person who develops agoraphobia as a result of post-traumatic stress will no longer be able to leave the house to go to work…
Post-traumatic stress can, of course, occur immediately after the event, but it can also occur several months or even years after the event. The disorders disappear within 3 months or become chronic in 20% of cases. There is also a 20% risk of relapse in patients who are treated.
5. Can we reduce the risk of developing post-traumatic stress? How to treat post-traumatic stress?
It is of course possible to limit the risk of developing chronic post-traumatic stress, for which it is essential to be treated by psychotherapy. Indeed, these therapies will allow a better understanding of the event, of the emotions felt afterwards, to understand what favors the appearance of the painful memories.
Among the therapies that have the best results on post-traumatic stress are EMDR and CBT.
EMDR is a therapy that consists of alternating bilateral (left/right) stimulation. This stimulation can be done through eye movements, tapping or sound.
CBTs are Cognitive-Behavioral Therapies. These therapies have now been widely proven in the treatment of post-traumatic stress. They will notably allow progressive exposure to anxiety-provoking situations or situations reminiscent of the trauma. CBTs work on the cognitive (modifying thoughts), behavioral (modifying maladaptive behaviors, avoiding avoidance) and emotional (learning to manage one’s anxiety) aspects. In the case of post-traumatic stress, the person will associate a place, a sound, a smell, an image… that reminds him of the event, to a danger. CBT will therefore allow the person to modify these associations.
CBT uses imaginative and in vivo exposure. However, for several years now, exposure through virtual reality has also been widely proven. Virtual reality will allow the patient to be exposed in a much more progressive way, to fully control the environment while keeping the person in a safe environment.
Many studies are underway to better understand the development of this type of disorder.
For example, a study by Butler et al. on the use of the game Tetris to limit the development of post-traumatic stress. They used it in addition to EMDR therapy. The results show an increase in the hippocampus in people who played Tetris in addition to EMDR therapy. This increase in hippocampus volume is associated with a decrease in PTSD symptoms, a decrease in depressive symptoms and anxiety. The increase in volume of the hippocampus would allow for a better maintenance of the acquired skills during EMDR treatment.
In all cases, as you will have understood, psychotherapy is necessary in order to limit the avoidance that prevents the traumatic memory from being processed like other memories.